Company Profile

The System Director Authorization Management Pre-Service leads and manages a team composed primarily of denial nurses, utilization review nurses (RN, LPN), pre-service and insurance verification representatives. This team develops processes for prospective, concurrent and retrospective utilization review. They provide timely notification of admission to third party payors and managed care companies. The team works closely with the hospital-based care managers and clinical offices to provide ...

The System Director, Revenue Integrity, is responsible for ensuring the integrity of the hospital and physician practice revenue cycle, assuring documentation reflecting registration, clinical service delivery, charging, coding, billing and remittance are accurate, complete, comprehensive and in compliance with regulatory and payor requirements. Key Accountabilities: Directs ongoing programs for education of physicians and ancillary staff regarding documentation and regulatory compliance. ...

The Director of Clinical Effectiveness and Care Management leads and manages a hospital-based team of professional staff, composed primarily of nurses and social workers. This team assesses plans, implements, coordinates, monitors and evaluates care, treatment and services to meet the patient's individual needs along with the healthcare continuum through providing utilization review services, care coordination, discharge planning and psycho-social services. Working collaboratively with physicians ...